COVID Poses New Challenges for the Field of Addiction Treatment, But Lowers Barriers for Treatment Options
In this post for our special series on social work in times of crisis, the HEALing Communities Study and the Columbia Center for Healing of Opioid and Other Substance Use Disorders–Intervention Development and Implementation (CHOSEN)—both major initiatives of the Social Intervention Group (SIG)—share lessons learned and some new directions and priorities for their current and post-COVID research agendas. HEALing Communities is a research study that aims to reduce opioid and overdose deaths in New York State by 40 percent in just four years. CHOSEN draws on the expertise of faculty, researchers and practitioners from across Columbia University to develop and implement programs, policies and practices that focus on addressing the negative health consequences caused by opioid and other substance use disorders.
For more than three decades, the Social Intervention Group (SIG), housed at the School of Social Work, has been developing and implementing evidence-based sustainable solutions to emerging health and social issues affecting diverse populations domestically and globally.
This past year was like no other in SIG’s history. The arrival of COVID in New York State in March 2020 posed enormous challenges for our top research initiatives in the field of addiction:
- The NIH-funded HEALing Communities study
- The newly opened Center for Healing of Opioid and Other Substance Use Disorders-Enhancing Intervention, Development and Implementation (CHOSEN)
Below we present some highlights of the past year for these two initiatives—including some silver linings that became apparent as the year progressed.
Launching a major study during a pandemic
SIG received a history-making NIH grant—one of the largest grants in Columbia’s history—in April 2019, almost exactly one year before the pandemic arrived. Our charge was to launch a study with the ambitious aim of reducing opioid-related deaths by 40 percent across 16 heavily affected New York State counties, within just a few years. The National Institute on Drug Abuse is supporting our research, which is part of a larger trans-agency effort, called the HEALing Communities Study, to speed scientific solutions to America’s opioid overdose epidemic, a nation-wide public health crisis.
Led by SIG’s director, University Professor Nabila El-Bassel, our team consists of scientists from several Columbia schools and outside institutions. A few months before the coronavirus arrived in New York, team members traveled to the 16 targeted counties with the aim of beginning the implementation phase in early 2020. When the pandemic hit, we were busy building coalitions in half of those communities (what we call our “8 Wave One Communities”) consisting of stakeholders who are invested in reducing opioid overdoses—many of whom work in health and mental health departments, hospitals, jails, law enforcement, and drug treatment and behavioral health centers.
The next thing we knew, our community partners were all struggling to balance the competing demands of an overdose epidemic and a pandemic. They were casting about for ways to adapt their services, care for staff and clients, and stay afloat financially while also trying to honor their commitment to our study with its goal of preventing more opioid-related deaths. Many of these organizations had no choice but to reduce their hours and services for people at risk of opioid overdose, placing these individuals at increased risk of death.
Given these challenges, we were impressed at the speed by which our community partners were able to move to Zoom-based interaction, demonstrating their strong desire to connect with us and each other for mutual support and to integrate the goals of opioid overdose prevention into their operations. Within just a few months, attendance at our monthly coalition meetings, and even some of our weekly workgroups, became more consistent and diverse, an encouraging sign.
A period of creativity, not seen for decades
Crises sometimes spur innovation. Federal and state governments responded to the COVID emergency by introducing sweeping temporary changes in federal and state regulations and health plan reimbursement policies. For the first time in decades, longstanding barriers to delivering addiction treatment services were reduced, enabling healthcare providers to be innovative in order to try to meet the needs of the most vulnerable among us.
As far as the SIG-led HEALing Communities study was concerned, the new regulatory environment took us from a place where we were worried about reaching the individuals in the eight counties from our first wave—many of whom had become isolated by the pandemic, putting them at increased risk for overdose—to a place where we could be more creative with our messaging and service delivery methods. A telehealth-based program enabled providers to continue prescribing Naloxone (an antidote to opioid overdose), which were then distributed through the mail. Telehealth has also proved to be an effective platform for delivering counseling for retention to the treatment program.
This new-found creativity, and the ability it gave us to reach more individuals, has truly been one of the pandemic’s silver linings.
The power of science, and community collaboration, in crisis
Over the past year, we have seen what happens when two public health crises collide, watching with trepidation as individuals at risk of opioid overdose faced the additional challenges posed by COVID of social isolation, vanishing support systems, and greater difficulty and changes in accessing treatments and medications.
But also during the past year, we have been struck by the response of the scientific and treatment community to these unprecedented challenges.
Using virtual meetings, the HEALing Communities team continued to connect with its communities, many of which were disproportionately impacted by these dual health challenges, for shared problem-solving and intervention planning. In the process, we discovered that community-based participatory research comes into its own during a crisis. By forming partnerships with those with lived experience of substance use disorder and those working on the ground, we were already tapping into the power of collective action that has become so essential for moving forward from the pandemic.
But probably the most significant development of the past year lay in reducing the barriers for accessing services through telepractice and pharmacy-based partnerships. Thanks to the lowered regulatory requirements, many more individuals have been able to receive treatment—a trend we hope to see continue post-pandemic.
New communication tools, fresh priorities for CHOSEN
The Center for Healing of Opioid and Other Substance Use Disorders-Enhancing Intervention, Development and Implementation (CHOSEN) was created at Columbia in March 2020, right before the pandemic struck. So as not to lose the momentum, the CHOSEN team, comprising researchers from across Columbia, converted to virtual communications using video conferencing software and cloud-based technology. Fortunately, several team members were able to contribute their previous experiences with these technologies in training others.
A year later, the CHOSEN team has come to regard the use of video conferencing technology as part of our new normal. The technology has allowed for more flexibility and greater geographical reach in the effort to develop and maintain research collaborations across disciplines and time zones. In addition, we have been tapping into the benefits of web-based data collection methods.
Mirroring the developments within the HEALing Communities study, Columbia’s CHOSEN team has begun prioritizing research projects that look at:
- How regulations governing delivery of services to those with substance use disorders were developed, adopted, and implemented during COVID-19.
- The impact of the new regulatory guidelines, along with recommendations for maintaining these policies post-COVID.
As with other infectious diseases, people with substance use disorders are much more vulnerable to COVID-19. Moving forward, the CHOSEN team is likely to continue to do research in this area to understand the impacts of COVID-19 on this population and how services can be improved to address health disparities.
Timothy Hunt is the associate director of the Social Intervention Group and of CHOSEN. He is also a co-investigator for the SIG-led HEALing Communities Study. Brandy Henry is a clinician scientist and post-doctoral research fellow within SIG’s T-32 program.